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Genetic Testing May Help Decision to Avoid Breast Cancer Chemotherapy

Expert Analysis Highlights:

  • Genetic test (oncotype DX) aids decision as to whether or not to undergo chemotherapy after surgery
  • Profile of the breast cancer genes can be used to predict whether or not there is a survival benefit of adding chemotherapy to hormone therapy
  • Test is covered by most private insurance and by Medicare
  • A good starting place to learn more  is the section on predicting recurrence and genetic testing on our companion website

Genetic testing may help decisions to avoid breast cancer chemotherapy. For some women with early stage breast cancer, a genetic test (oncotype DX) may be helpful to you and your oncologist when deciding whether or not to undergo chemotherapy after surgery. This test is made on the breast cancer itself for which a multi-gene assay is performed to determine the “genetic signature” of your tumor. The profile of the breast cancer genes can then be used to predict with accuracy whether or not there is a survival benefit of adding chemotherapy to hormone therapy for those women who have hormone-responsive (ER+) breast cancer, especially those who are post-menopausal. This assay has been recommended both by the Guidelines of the American Society of Clinical Oncology and the National Comprehensive Cancer Center. When indicated, the test is covered by most private insurance and by Medicare.

Those women for whom the genetic testing may yield valuable information are two groups:

  1. Women who have no evidence of spread to their lymph nodes and whose breast cancer expresses hormone receptors (estrogen-receptor-positive) and
  2. Women after menopause whose cancer has spread to their regional lymph nodes and whose breast cancer is hormone-receptor-positive.

In both of these circumstances hormone therapy with either Tamoxifen or one of the aromatase inhibitors (Arimidex, Latrozole, etc.) would be indicated as standard therapy for at least five years. The side effects in most women are very tolerable, if not minimal. On the other hand, chemotherapy has more side effects and should be considered only when the potential survival benefit outweighs the risk or toxicity of receiving drug therapy in addition to hormone therapy.

Ask your doctor about this genetic test if you have the stages of breast cancer described above. Though advances in cancer chemotherapy have been dramatic, especially in breast cancer, it is equally valuable to know which women have such a good outcome after surgery and hormone therapy that they do not otherwise get from additional chemotherapy.

In the March 8,2010 issue of the journal Cancer, researchers at the University of North Carolina surveyed 77 women with breast cancer who underwent genetic testing. One-third reported that they did not understand the doctor’s explanation of the genomic test and one-quarter felt distress as a result of the discussion. On the other hand, most women agreed that genetic testing helped them understand whether their treatment would be successful. I learned from this article that:

  1. Doctors need to do a better job of educating patients and explaining the test results, and
  2. Patients need to get enough basic information and knowledge of the jargon (terminology) of these tests so they can understand the results and the meaning behind them.

A good starting place to learn more  is the section on predicting recurrence and genetic testing on our companion website, patientresource.net.

Also for more information, go to www.oncotype.com or review the Guidelines from ASCO at www.Cancer.net or NCCN at www.nccn.org.

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